How basic psychological needs and motivation affect vitality and lifelong learning adaptability of pharmacists: a structural equation model

Insufficient professional development may lead to poor performance of healthcare professionals. Therefore, continuing education (CE) and continuing professional development (CPD) are needed to secure safe and good quality healthcare. The aim of the study was to investigate the hypothesized associations and their directions between pharmacists’ basic psychological needs in CE, their academic motivation, well-being, learning outcomes. Self-determination theory was used as a theoretical framework for this study. Data were collected through four questionnaires measuring: academic motivation, basic psychological needs (BPN), vitality and lifelong learning adaptability of pharmacists in the CE/CPD learning context. Structural equation modelling was used to analyze the data. Demographic factors like gender and working environment influenced the observed scores for frustration of BPN and factors like training status and working experience influenced the observed scores for academic motivation. A good model fit could be found only for a part of the hypothesized pathway. Frustration of BPN is positively directly related to the less desirable type of academic motivation, controlled motivation (0.88) and negatively directly related to vitality (? 1.61) and negatively indirectly related to learning outcomes in CE. Fulfillment or frustration of BPN are important predictors for well-being and learning outcomes. Further research should be conducted to discover how we can prevent these needs from being frustrated in order to design a motivating, vitalizing and sustainable CE/CPD system for pharmacists and other healthcare professionals. Basic psychological needs are very important predictors for well-being and learning outcomes. Further research should be conducted to discover how we can prevent these needs from being frustrated in order to design a motivating, vitalizing and sustainable CE/CPD system for pharmacists and other healthcare professionals.     

Occupational generalized urticaria and anaphylaxis after inhalation of cefuroxime in a nurse

We present the case of a 53 years old nonatopic female nurse who experienced repeated anaphylactic reactions at work without involvement in drug‐specific tasks such as crushing of tablets or preparation of injections. The causal allergen was not identified until a further severe anaphylactic reaction occurred after oral use of cefuroxime during a respiratory infection. Sensitization to cefuroxime was demonstrated by specific IgE, basophil activation test and skin prick test. An inhalation challenge with a dosimeter induced generalized urticaria after a cumulative dose of about 10 μg of the drug, but no asthmatic reaction. Complete exposure cessation was initiated and a 1‐year follow‐up was without further allergic reactions. We conclude that work‐related systemic allergic reactions to β‐lactam antibiotics may occur in nurses after inhalation of low doses and without perceived association with drug‐specific tasks like handling of antibiotics.

     

Using a multidisciplinary classification in nursing: the International Classification of Functioning Disability and Health

AIM: This paper reports a study to explore systematically the usefulness of the International Classification of Functioning, Disability and Health to nurses giving patient care. BACKGROUND: The International Classification of Functioning, Disability and Health has a history of more than 20 years. Although this World Health Organization classification offers multidisciplinary use, nurses are not familiar with it. METHODS: Applications of the International Classification for nursing practice were developed and evaluated in a multi-centre project, composed of a series of 10 projects in a variety of settings. These applications were a variety of tools, such as assessment forms, care plans and transfer forms. The study used information from 653 patients, 469 nurses and 178 others (International Classification experts; other professionals with whom nurses communicate or discuss patient data). FINDINGS: Large sections of the International Classification were used in the 10 projects, revealing a predominant focus on body functions (53% of all three-digit codes and corresponding terms used). Although large sections of the Classification were useful in practice applications, some items were identified that could be added, improved or described with more detail. Positive remarks made by nurses referred to the scope of the International Classification, which encouraged assessing beyond a patient's functional impairments. CONCLUSIONS: The International Classification of Functioning, Disability and Health can be a useful tool in classifying and communicating aspects of patient functioning by nurses. A level of moderate detail within the Classification (three-digit level) seems appropriate for most nursing purposes. Our results on items that could be added or improved can serve as input in future revisions of the Classification. Future use of the International Classification should be encouraged, because of its relevance to nursing and its potential for multidisciplinary use in patient care.     

Effects of oral cisapride on interdigestive jejunal motor activity,psychomotor function,and side-effect profile in healthy man

Intravenous cisapride was shown to induce a phase-2-like pattern of human interdigestive jejunal motor activity containing an increased number of propagated contractions. This study investigated the effects of oral cisapride in 12 fasting healthy males. Jejunal pressures were recorded by a pneumohydraulic system and five catheter orifices positioned 10–30 cm aborad the ligament of Treitz. Single oral doses of 5 and 10mg cisapride, administered 5 min after an activity front under random double-blind conditions, induced a phase-2-like jejunal motor pattern with a significantly higher number and amplitude of contractions and significantly more aborally propagated waves than placebo (P<0.001), while the number of subjects with activity fronts decreased with increasing dose. Five and 10mg cisapride administered tid for three days affected psychomotor function, subjective feelings, and side-effect frequency, apart from increases in systolic blood pressure and heart rate, no more than placebo. It is concluded that in fasting man, oral cisapride induces a highly propagative phase-2-like jejunal motor pattern causing only minor side effects.     

Psychometric characteristics of the Mini-Mental State Examination in a community population— A grade of membership analysis: Part I

The Mini-Mental State Examination (MMSE), a brief, widely used measure of cognitive status, was designed to assess functioning in five areas (orientation, registration, attention and calculation, recall and language). Using a grade of membership analysis, which does not rely on a multivariate normal distribution or assume an underlying continuum for dichotomously scored variables, we examined data from a sample of 1317 community residents 18 years of age and older who made two or more errors on the MMSE. Our findings suggest that for these primarily cognitively intact persons, the items of the MMSE varied in level of difficulty; multiple distinct areas of cognitive functioning were not identified. The results of confirmatory testing using clinic populations with cognitive deficit are given in the accompanying article.     

Larger amygdala volumes in first depressive episode as compared to recurrent major depression and healthy control subjects.

BACKGROUND: The aim of our study was to test the hypothesis that amygdala volumes are reduced in patients with recurrent major depression compared with first episode patients. METHODS: Using structural magnetic resonance imaging, we compared 30 inpatients with first-episode depression and 27 inpatients with recurrent major depression (DSM-IV) with healthy volunteer subjects from the local community matched for age, gender, and handedness. RESULTS: Patients with first-episode depression showed enlarged amygdala volumes compared with patients with recurrent major depression and healthy control subjects. No significant differences were found between patients with recurrent depression and healthy control subjects. No significant correlations were found between amygdala volumes and age of onset, illness duration, or severity of depression. CONCLUSIONS: Larger amygdala volumes in patients with first-episode depression may result from higher amygdala metabolism and blood flow. Additionally, disease progression with stress-related excitotoxic processes during recurrent depressive episodes might result in decreased amygdala volumes. Prospective investigations to investigate amygdala changes during the course of depression are needed.     

Reforms in VUmc School of Medical Sciences Amsterdam: Student engagement,a Minor elective semester and stakeholder collaboration in improving the quality of assessments

Abstract

Background: At VUmc School of Medical Sciences, major curricular reforms occurred in 2005 and 2015, related to the introduction of a Bachelor-Master structure, a new legislation from the Ministry of Education, the changing societal context, and taking note of students’ and teachers’ needs.

Summary of work: Along with the introduction of the Bachelor-Master system, the period between 2005 and 2009 saw the movement from traditional lecture-based teaching to small group teaching in a competency-based curriculum, in which the students were responsible for their learning. Student engagement grew through students’ designing learning modules and conducting some of the teaching. In the Bachelor program, an elective “Minor”, was designed to broaden and deepen the knowledge of our students beyond the core learning outcomes, in a discipline of their choice. The examination board (EB), responsible for maintaining the quality of assessment, was split into the General EB, which handled overall strategy issues, and the Executive EB, which handled student requests and monitored the quality of assessments.

Lessons learned: Students develop a sense of what education is about if they are provided opportunities in designing teaching and conducting it. A Minor elective in the medical study can provide the students with an opportunity to learn outside the medical field. Collaborative working between different stakeholders in a medical school is crucial for safeguarding the quality of assessments. Curricular reforms need time to be accepted and integrated into the culture of the medical school. The educational vision needs to be refreshed regularly in alignment with the changing societal context.     

Relationship of race/ethnicity and blood pressure to change in cognitive function

OBJECTIVES: To determine whether there are racial/ethnic differences regarding the relationship of level of blood pressure to change in cognitive function in older people. DESIGN: Longitudinal data 1986 to 1989 on representative, older, community-residing African Americans and whites. Blood pressure levels were assessed and a brief screen of cognitive functioning, the Short Portable Mental Status Questionnaire (SPMSQ), was performed at baseline and 3 years later. SETTING: Five contiguous counties in the Piedmont area of North Carolina. PARTICIPANTS: African-American (n = 2,260) and white(n = 1,876) participants in the Duke Established Populations for Epidemiologic Studies of the Elderly, aged 65 to 105 at baseline. MEASUREMENTS: The outcome measure was change in SPMSQ score over 3 years. Covariates included age; education; gender; self-reported diabetes mellitus, stroke, heart attack, current smoking, and depressive symptomatology;and use of antihypertensive medication. The primary independent variable was measured blood pressure. RESULTS: In unadjusted analyses, a statistically significant U-shaped relationship was found between systolic (but not diastolic) blood pressure levels and change in SPMSQ score over a 3-year period for older white men and women. No such relationships were found between these blood pressure measurements and change in SPMSQ score in older African Americans. These findings remained after adjustment for initial SPMSQ score, demographic characteristics, and use of antihypertensive medication. There were no significant interactions between race and blood pressure on change in cognitive function. CONCLUSION: Decline in cognitive function was associated with extremes of systolic blood pressure in older white people. Although a similar but muted nonsignificant association was found in older African Americans, the curves for the two groups were not significantly different. Further studies in older African Americans are needed.     

Relapse of Philadelphia chromosome positive acute lymphoblastic leukaemia after marrow transplantation: sustained molecular remission after early and dose-escalating infusion of donor leucocytes

We present a patient who underwent sibling allogeneic BMT because of refractory Ph+ve ALL and remained BCR-ABL-positive after marrow grafting. Haemopoietic precursor cells were predominantly BCR-ABL-negative and of donor origin. In T cells an exclusively donor genotype was demonstrated. Despite donor leucocyte infusion (DLI), 20 weeks after BMT BCR-ABL fusion mRNA increased in semiquantitative polymerase chain reaction and leukaemic infiltration of the patient's bone marrow was seen. After a second course of DLI the patient achieved sustained molecular remission but he developed severe graft-versus-host disease (GvHD) and died from bacterial sepsis 9 months after DLI.